Barack Obama’s Difficult Reform of Healthcare

It was one of the flagship promises of the Democratic candidate in the presidential campaign last year: reform of the United States healthcare system. Unfortunately, the reform is getting into more and more problems, to the point of posing questions about the president…

A Necessary but Difficult Reform

The United States healthcare, without a doubt, has taken the prize for the system that functions the worst. In fact, even though healthcare engulfs 16 percent of the GDP (that is 50 percent more than any other country, twice the amount of some), not only is the country not well cared for (it is classified as 37th in global rankings, according to the WHO), but furthermore, 15 percent of the population is just not covered. In short, it realizes the tour de force of not covering everyone, while being the most expensive and most inefficient…

This is why the reform proposed by the new president might seem obvious. Its objective is twofold: reduce costs and cover all of the population. A priori, nothing shocking. Except that the debate in the United States has become a caricature that is completely disconnected from reality. The partisans of the status quo (whom we could ask how they could oppose the reform of a system that works so badly) use terrible arguments to attack the healthcare reform project.

They talk about a “communist” system and the setting up of administrative “death panels” who decide if a person has the right to be cared for or not. The opponents of healthcare reform do not shrink from using any exaggeration that could discredit it. Republicans use this reform to try to attack the Obama administration, which they desire to “Carterize.” Certain moderate Democrats have begun to hesitate before the violence of critics and the risk of negative publicity.

A Difficult Country to Reform

The situation promises to remain difficult for two reasons internal to the United States. First, a majority of the country is still opposed to the reform. The reasons are simple. According to a YouGov poll cited by The Economist, 20 percent of the population thinks it can profit from reform and 40 percent thinks it will lose. But most importantly, nearly 70 percent of Americans think that the principal problem is the cost of the system, compared with 25 percent who think that the primary problem is the lack of coverage for 15 percent of the population.

Result: Barack Obama’s primary objective – even though he announced it in his campaign – is disconnected from the expectations of the population. Worse, any attempt of supervising the spending on healthcare is seen as an unsupportable intervention of the administration in the life of U.S. citizens, and it is immediately classified as “communist” or “Soviet”; the ultimate insult. Result: the plan that members of Congress and the Senate are working on is getting farther and farther away from Barack Obama’s objectives.

It ends up concentrating on cost reductions that are even more difficult to get accepted, and all the members of Congress fear that their vote will then be used against them in negative publicity campaigns that twist reality and could make them responsible for the death of this or that person. The members of Congress are not working calmly.

Barack Obama’s Errors

This makes us touch upon the questionable choices of the president. Remembering the failure of Hillary Clinton’s plan, when the House refused a plan concocted in the White House, Barack Obama trusted that it would be realized by the Senate. But as happened with the economic stimulus and the climate plan, this leaves the door open to lobbies and fears of negative campaigning. Result: this subcontracting holds back reform and gives the power to conservative Democrats (“blue dogs”).

The center of political gravity in the United States has remained far to the right in spite of Barack Obama’s election. Contrary to Franklin Roosevelt, who didn’t hesitate to make extremely divisive proposals, Barack Obama has held a very centrist position, which, though it has the advantage of being very difficult to attack in campaign, doesn’t prepare the country for difficult choices. He carries part of the responsibility in the fact that he wasn’t more precise and clear about the changes that he wished to bring about.

This reform can make or break the Obama administration. The president of the United States understands this well and is putting all his energy toward trying to frame a debate in deplorable extremes.